Critical Care Nursing

Question 2

Your client has just returned from surgery for removal of an abdominal tumor. The postoperative arterial blood gas values are pH 7.34 PaCO2 53 mmHg HCO3 25 mEq/L PaO2 70 mmHg SaO2 91%

The nurse should

• have the client breathe into a rebreather bag at a slow rate.
• prepare for intubation.
• encourage the client to cough productively and take deep breaths.
• obtain a medical order for the administration of sodium bicarbonate.

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Question 3

On an intubated client which of the following interventions would potentially correct ABG results indicating respiratory acidosis?

• Sedate and paralyze the client
• Increase the rate and/or tidal volume
• Increase the PEEP
• Increase the FiO2 and/or PEEP

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Question 4

Which arterial blood gas (ABG) report would the nurse expect in a client developing early ARDS?

• pH 7.34; PaCO2 25 mmHg; PaO2 80 mmHg; HCO3 19 mEq/L
• pH 7.50; PaCO2 28 mmHg; PaO2 58 mmHg; HCO3 24 mEq/L
• pH 7.34; PaCO2 60 mmHg; PaO2 68 mmHg; HCO3 30 mEq/L
• pH 7.50; PaCO2 28 mmHg; PaO2 100 mmHg; HCO3 24 mEq/L

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Question 5

A client is admitted to ICU. Blood gases are pH 7.03; PCO2 37mmHg; HCO3 8 mEq/L. The medication most likely to be ordered to correct this acid-base imbalance is

• calcium carbonate.
• sodium bicarbonate.
• acetazolamide.
• carbonic acid.

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Question 6

Your septic client is becoming restless and tachypneic. His arterial blood gases show pH 7.30; PaCO2 50 mmHg; HCO3 24 mEq/L; PaO2 76 mmHg; SaO2 90%. You would interpret these ABG findings as consistent with

• acute ventilatory failure.
• early acute respiratory distress syndrome.
• late acute respiratory distress syndrome.
• normal ABG results.

Question 7

The nurse is caring for a client who is being mechanically ventilated. What strategies have been shown to prevent ventilator-acquired pneumonia (VAP)?

• Routine prone positioning
• Changing ventilator circuit tubing every 72 hours
• Elevate head of bed 30 to 45 degrees if not contraindicated
• Administration of IV antibiotics routinely

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Question 8

As the nurse caring for a ventilator-dependent client who is receiving vecuronium bromide, you assess the level of neuromuscular blockade using “Train-of Four” (TOF) peripheral nerve stimulation. When would you know you have the correct amount of the paralytic being delivered?

• The client displays three out of four twitch responses.
• The client displays zero twitch responses.
• The client displays one to two out of four twitch responses.
• The client can blink their eyes on command.